After conception, the fertilized egg divides repeatedly into a mass of cells. The germinal period is the period of prenatal development that takes place in the first 2 weeks after conception. By 1 week after conception, the fertilized egg is composed of 100 to 150 cells. These cells have differentiated into 2 layers, an inner and outer layer. The blastocystis the inner layer of these cells that develop during this period and later develop into the embryo. The outer layer is the trophoblast which also develops during this period and later provides nutrition and support for the embryo. About 10 days after conception, the fertilized egg or now called a zygote, attaches to the inner wall of the uterus.

2 To 8 Weeks: Embryonic Period

The embryonic period occurs 2 to 8 weeks after conception. During this period the rate of cell differentiation intensifies, with support systems and organs beginning to form. The zygote now forms another 2 layers of cells and is then called an embryo. The embryo’s new inner layer of cells, the endoderm, later develops into the digestive and respiratory systems. The outer layer is then further divided into 2: the ectoderm and the mesoderm. The ectoderm later becomes the nervous system and sensory receptors (ears, nose, and eyes, for example) and skin parts (hair and nails, for example). The mesoderm later becomes the circulatory system, bones, muscles, excretory system, and reproductive system. Every body part eventually develops from these 3 layers.

As the 3 layers form, the embryo’s life support systems begin to mature and develop rapidly. These life support systems include the placenta, the umbilical cord, and the amnion.
placenta – consists of tissues where blood vessels between the mother and baby intertwine.
umbilical cord – contains 2 arteries and a vein, connects the baby to the placenta. Nutrients from the mother’s blood and digestive wastes from the baby’s blood can now pass back and forth between mom and baby.
amnion – a pouch containing a clear fluid that envelopes and protect the developing embryo.
GROWTH: At the third week the neural tube that becomes the spinal cord begins to form. At 21 days, eyes begin to appear and at 24 days, cells for the heart begin to differentiate. During the fourth week, arm and leg buds emerge. When organs are being formed, they are vulnerable to environmental changes.

2 To 9 Months: Fetal Period

Growth and development continue dramatically during the fetal period. Three months after conception, the fetus is about 3 inches long and weighs about 1 ounce. It has become very active, moving its arms and legs, opening and closing its mouth, and moving its head. The face, forehead, eyelids, nose, chin, arms, hands, and lower limbs are now distinguishable, and the genitals can be identified as male or female. By the end of the fourth month, the fetus is about 6 inches in length and weighs 4 to 7 ounces. By the end of the 5th month, the fetus then grows to 12 inches long and weighs close to a pound. Its toenails and fingernails have begun to form and is more active, showing a preference for a particular position in the womb. By the end of the 6th month, a thin layer of hair has formed and irregular breathing occurs. By the end of the 7th month, the fetus is now about 16 inches long and weighs about 3 pounds. During the 8th and 9th months, the fetus rapidly gains another 4 pounds. At birth, the average American baby weighs 7 pounds and is about 20 inches long.

• 16 1/2 to 18 inches long and weighs 4 to 5 pound
• Periods of sleep and wakefulness
• Responds to sounds
• May assume birth position
• Bones of head are soft and flexible
• Iron is being stored in liver

City and State programs provide free services to families based on a child’s age and needs. Services accessed for children ages birth to 3 years are typically provided by city programs regulated and funded through the State’s Department of Health. These programs are called Early Intervention Programs. Services accessed for children ages 3 years and up are usually regulated through the State’s Board of Education Program. These programs are called,”Committee on PreSchool Special Education Programs (CPSE). All programs though regulated from separate sources, are aimed at assisting children in achieving their developmental goals in becoming school ready. Services may be obtained for free based on separate eligibility requirements for each of the 2 program types, and have the following purposes:
– to assist children with developmental delays in becoming school ready so they do not fall behind in the school system
– to identify early, any conditions or disorders associated with learning

Early Intervention

As mentioned above, Early Intervention Programs are city and state programs regulated and funded by each state’s Department of Health. Every state has an Early Intervention Program available to provide eligible children with services to help children ‘catch up’ in their development. Early Intervention Programs are not typically advertised and are usually referral based with most referrals coming from Pediatricians and other parents. Early Intervention Programs within each State do not necessarily provide the actual services, they only fund and approve them. Early Intervention “Providers” are private or non-profit businesses that actually provide the services and then bill the State or City’s Early Intervention Program. To obtain services for your child you must first contact your State’s Early Intervention Office, to find out which providers are nearest you, and then choose an Early Intervention Provider that best suites your child’s needs. Many EI Providers have their own specialties, for example ‘United Cerebral Palsy, (UCP)”, provides EI services to all children eligible and of course may have many more resources to services for children with Cerebral Palsy. You may call EI Providers and arrange to have a tour of their facilities to check them out before hand before choosing one. If you do so however, you must try not to waste too much time; the enrollment process can take long enough. It is not impossible for a child to go through a long evaluation process just in time to transfer out of the Early Intervention Program. I heard from a parent once that while choosing an Early Intervention Provider and touring their facilities, what helped her make her decision was the greetings she received from the staff. On one of her tours she was greeted by everyone passing by while in the waiting area, even the janitor had stopped to say hello to both her and her two sons. She claimed that this impressed her and that to see a facility where all the staff are both happy to work there and friendly, she knew she had made the right choice.

What types of services can I receive for my child through an Early Intervention Program?

The answer is: as many services that your child is eligible for that are out there. Typically you must have your child tested for eligibility first. Testing would determine your child’s estimated, developmental age for each of the 6 areas of development. From there your child could be eligible to receive services at home, in a classroom or even both, depending on your child’s age and needs. If your child tested as delayed in speech, then your child would be eligible to receive Speech Therapy either at home, one on one with a Speech Therapist, or at a center. A child could be eligible to receive services such as: Speech Therapy, Physical Therapy, Occupational Therapy, Special Instruction, Vision Therapy, Respite (home care), Daycare, medical, Parent Training, Family counseling, Psychological Play Therapy, and many more of course depending on your child’s and family’s needs.

THE EI Process:

1)You must first choose an Early Intervention Provider. Remember to not waste too much time in doing so; children grow fast and everyday counts.

2)Contact the provider to arrange testing. The provider you chose would first take your information and forward it to the Early Intervention Office in notification. EI will assign an ID number to your child and alert the provider to proceed with testing. This takes approximately 2-3 days.

3)A ‘Service Coordinator’ will be assigned to your child. This person may or may not be from the provider you chose though is there to advocate on your child’s behalf regardless. Your SC will explain to you your rights: that all information you provide is confidential, that these services are voluntary and that you may terminate services at any time, and that you have the right to choose any provider of services that best suites your child’s needs. The SC will wish to meet with you to obtain your signature for some consents and obtain your insurance information. EI plans on billing your insurance company for the services it will approve though you may refuse to provide this info – it is your right to refuse. You may only have to put your refusal in writing if you choose to do so. Typically you will not be billed by your insurance company and if you give this information, it will not affect your deductible. EI would be responsible for any bills you might receive by your insurance since they state that their services are at no cost to families.

4) Choose the place to have testing conducted. Most places allow you to choose to have testing conducted either at your home or at the center. Just know that testing will be conducted with your child by a stranger and if at a center, in an unfamiliar place. Testers understand this and know that your child may not perform typically which is why much of the testing is based on parent input. The tester will basically ask you the parent if your child has certain skills. To get a sample of the skills an evaluator will look to observe based on your child’s age, go to the “Milestones” page of this web site.

5) Test #1: The Developmental Test. The first test should be conducted by a Special Educator and will be a ‘general’ test. In other words, the test will not be specific to the individual areas of development. It will score estimated results of developmental ages in each of the developmental areas. For example, a 2 year old child may only score as a 1 year old in speech, and a 3 year old in physical development – thus having 1 year as the developmental age for speech and being 1 year delayed. Based on the results of this test, eligibility would be determined first to see if your child should need any specific tests. In the previous example, a year delay in speech would then merit the need for a more specific evaluation for your child’s speech. The person that conducts this first test would have at least a Master’s Degree in Special Education. The reason why a general, developmental test to look at all areas is performed first despite possibly that your concern may only be in your child’s speech for example, is that EI wants to be sure that if they are to provide a service, they must first learn that this service is the only service your child needs.

6)Other specific tests would then be conducted depending on the results of the developmental test. These might be a Speech evaluation, a Physical Therapy evaluation, etc. or multiple tests.

7)Eligibility is then determined from the results of testing. Typically your child must have a 33% delay in an area in order to receive services for that area. If your child is 33% delayed in one area already, then your child need only be 25% delayed in another area in order to receive services for that area. The Service Coordinator would be responsible for explaining the results of testing to you and also explain your rights as to what you can now do regarding these results. If you are not happy with the results or disagree, you may request a new test or discuss it at the meeting coming up.

8)Meeting with EI scheduled. Once eligibility has been determined, a meeting will then be scheduled by your Service Coordinator with Early Intervention. This meeting should include an EI Official Designee, at least one member of the evaluation team, your Service Coordinator, and anybody that you feel should be present.

9)The EI Meeting. At this meeting you will discuss what services you would like to receive for your child. An Individualized Family Service Plan will be formed based on the goals you wish your child to receive from Early Intervention Services. At this meeting you may voice your opinion regarding testing results and try to obtain approval for additional services available such as Parent Training, Respite (home or emergency care), or Family Counseling if needed and for example. Your Service Coordinator should be able to prepare you before hand as to what to expect of this meeting and what services you should be eligible to receive. You will determine the type of services that are best for your child – whether you wish to receive services at home or at an EI Center. A frequency of services will be recommended based on the evaluation results and based on the recommendations of the evaluators. A typical frequency for a service such as Speech Therapy for example, would be 30 minutes, 2 or 3 days a week. All services approved at this meeting will be approved in 1 year intervals up until your child turns 3 years of age. Every 6 months your Service Coordinator will wish to meet with at least one of the therapists assigned to your child and review the the goals outlined in the IFSP and your child’s progress. Based on your child’s progress or lack of progress, every 6 months in this review, you may opt to change your service plan to include additional services, additional days, less days, longer sessions, etc. Your Service Coordinator would be responsible for assisting you with any of the changes you would like to make.

10) Services. You may interview and screen the therapists who get assigned to work with your child. If for any reason you feel that a particular therapist is not doing well with your child, you may opt to have a new therapist. Consider however, that therapist’s availability may be limited and there may be a wait for an available therapist. It is also your right to be present during or at least observe all the therapy sessions. Just keep in mind that being present during the sessions may distract your child and render the sessions
useless. Therapists are required to go over the session with you so make sure you learn what it is they are doing in the sessions. It is important that you learn these things and help carry them over after the therapy sessions so your child benefits most from therapies.

Cognitive Development:
This area defines a child’s ability to think, process information, learn and solve problems. There are several theories that describe the skills and processes associated with infant learning and taught in schools today. Such skills and information processing and are: object permanence (ability to understand that objects and events continue to exist even though the infant is no longer in contact with them), attention, symbolic play, imitation,conceptual ability, habituation (the repeated presentation of the same stimulus causing reduced attention over time), and memory. Several developmental tests are used today and were developed based on these theories. Some of the more common tests used are The Bayley Scales of Infant Development and The H.E.L.P. Checklist. Such tests evaluate an infant’s auditory and visual attention, manipulation of objects and toys, interaction with examiner and imitation, memory involved with object permanence (like finding hidden toy), goal-directed behavior involving persistence (like peg board, shape sorter), ability to follow directions, knowledge of object names and understanding concepts (such as concept of ‘one’).
Milestones associated with this area are: identifies self in mirror(15-16 months), identifies 6 body parts(22-24 months) and completes 3-4 piece puzzle (30-36 months).Children who are tested and found delayed in this area would be recommended to receive “Special Instruction” services either at home, in a classroom setting or both, depending on the child’s needs and age. A Special Education Teacher would be serviced to assist a child’s development in this area. Special Instruction in a classroom setting also overlaps with learning skills in each of the other areas as well due to many of the classroom activities.

Communication Development:Language: In an infant’s first few months, sharp noises can show a startle response. At 3 to 6 months, infants can begin to show an interest in sounds, play with saliva, and respond to voices. In the next 3 to 6 months, babbling can begin and is determined mainly by biological maturation, not so much reinforcement, hearing, or care-giver-infant interaction. It has been found that deaf babies can begin to babble at this time. The purpose of a baby’s earliest communication is to attract attention from parents and others in the environment. This is usually accomplished by a baby making and breaking eye contact, by vocalizing sounds, or by performing manual actions such as pointing. All of these behaviors involve the aspect of language called pragmatics.
The environment can play a significant role in communication development. It is encouraged for babies to be bathed in language very early by speaking to them extensively, especially about what the baby is attending to at the moment.

Communication is divided further into 3 areas when assessed:

Receptive Speech: This area is defined as a child’s ability to understand words as they are spoken to them. It involves understanding directions in steps, answering questions or responding appropriately when spoken to.

Expressive Speech: This area defines a child’s ability to produce sounds in expression of wants and needs; the child’s ability to appropriately speak. It involves vocalizing all needs, vocabulary building and identifying by name.

Oro-Motor: This is the physical aspect responsible for speech; it involves the oral mechanics behind sound production. Since this area of speech focuses on muscles of the mouth, movement of the tongue, reflexes and coordination, both Speech Therapists and Occupational Therapists work with children for this area.

Some of the milestones in infant communication are: babbling(3-6 months), first words understood(6-9 months), growth of receptive vocabulary(reaches 300 words or more by age 2), first instructions understood (9 months to 1 year), first word spoken(10-15 months), and the growth of spoken vocabulary(reaches 200-275 words by age 2).

Speech Therapists typically work with children delayed in this area either one to one at home, at a center, in a speech group, or in a classroom. Occupational Therapists overlap with respect to oro-motor, and Special Education Teachers overlap in this area with respect to working with a child’s speech in the classroom.

Physical Development (gross motor):
This area involves the development and coordination of large muscle groups. At birth, an infant does not have significant coordination of chest and arms, yet in the first month an infant should lift its head from a prone position. At about 3 months, an infant should hold its chest up and use its arms for support after being in a prone position. At 3 to 4 months, infants should roll over, and at 4 to 5 months, they should support some weight on their legs. Other skills associated with this area are rolling over, holding head up, walking, balance and ascending/descending stairs. The actual month at which the milestones occur varies by as much as 2 to 4 months, especially among older infants. What remains fairly uniform however, is the sequence of accomplishments. As each skill is learned, so does the level of independence as well.

Physical Therapists are serviced to work with children delayed in this area, typically on a one to one basis. A common condition that occurs in children who were breached or born of multiple births and in need of physical therapy, is torticollis. If a child is in a constraining position while in the womb, muscles can become tightened and in the case of torticollis, the neck muscle is tightened. In this case a child would be born with his/her head tilted to one side. Physical therapy for a few months, 2 or 3 times a week and some parental carry-over exercises could relieve this condition.

Hand/Eye Coordination (fine motor):
This area involves the delicate coordination of smaller muscles and muscle groups such as hands, fingers, mouth and eyes. Infants have hardly any control over fine motor skills at birth, although they have many components of what later become finely coordinated arm, hand, mouth and finger movements. Skills associated with this area involve reaching and grasping, manipulating objects, coloring with a crayon, grasping objects appropriately, following objects with eyes, and later, feeding oneself and being toilet trained. This area can also include two other areas of development:

Feeding: This area is focused on oro-motor development. By stimulating certain areas of the mouth with foods and therapeutic devices, a child may learn to coordinate the mouth muscles necessary for speech and eating various textured foods. Occupational and Speech Therapists work with children in this area.

Sensory Development: This area of development involves sensory integration; it involves how a child tolerates touching all textures like sand or water, tolerates loud noises, tolerates being touched, and tolerates being picked up off the ground. Occupational Therapists work with children in this area. Occupational Therapy focuses on these areas and may at times involve other therapies such as Speech and Physical Therapy. A child with delays in motor planning/coordination may need Physical, Occupational and Speech Therapies, for example.

Social/Emotional Development:

This area involves a child’s ability to display and identify emotions such as fear and anger, for example. It is also the area that involves attachment, temperament, how a child acts in social situations such as greeting people hello or goodbye, sharing attention with another, and looking at another for approval. Emotions are the first language that parents and infants communicate with before the infant acquires language. various emotions occur at different ages – for example, a social smile (4-6 weeks), surprise (3-4 months), and shame (6-8 months).

Attachment to a caregiver intensifies at about 6 to 7 months of age, and can be classified by three areas: secure – assumed optimal for development, avoidant, or resistant. An infant’s temperament (such as easy, difficult, or slow to warm up) is strongly influenced by biological factors but becomes more malleable with experience. Psychologists, Social Workers and classroom settings all play key roles in working with children delayed in this area.

Adaptive/Self Help Development:

This area involves a child’s independence, ability to do things for one’s self, and a child’s ability to adapt to the environment. As children progress in physical and coordination development, they have more opportunities to explore their environment and gain independence. Skills associated with this area are feeding oneself, opening door independently, unzips/zips zipper and going in potty independently, for examples. Occupational Therapists and Special Instruction Teachers typically work with delayed children in this area.

How could I know the difference between a warning sign and an appropriate behavior?answer: Know the warning signs.

These disorders of Infancy and Early Childhood are characterized by persistent disturbances in feeding and eating (DSM-IV).

Pica
Pica is significant for the persistent eating of nonnutritive substances which may vary with age. Infants and younger children are typically found to eat string, hair, plaster, paint, or cloth. Older children may tend to eat animal droppings, sand, insects, leaves, or pebbles. Adolescents may eat soil or clay. These eating behaviors would be developmentaly inappropriate and typically associated with other mental disorders. Specific symptons significant of this disorder are:• Persistent eating of nonnutritive substances
for at least 1 month
• The eating of nonnutritive substances is
inappropriate to developmental level
• The eating behavior is not part of a culturally
sanctioned practice
• It is sufficiently severe to warrant independent
clinical attention

Rumination Disorder
Rumination Disorder is known for the repeated regurgitation and rechewing of food that develops in infants or children after a period of normal functioning. Partially digested food is brought back up to the mouth without apparent nausea, retching, disgust or associated gastrointestinal disorder. The food is either ejected or more frequently, chewed and reswallowed. These symptoms would not be due to another medical condition. (DSM IV). Infants and children are typically irritable and hungry between episodes of regurgitation having this disorder. Specific symptons significant of this disorder are:• Repeated regurgitation and rechewing of food for
at least 1 month following a period of normal functioning
• These behaviors are not due to an associated
gastrointestinal or other medical condition
• Symptoms are sufficiently severe to warrant
independent clinical attention

Feeding Disorder
Feeding Disorder is significant for its persistent failure to eat adequately, as reflected in significant failure to gain weight or significant weight loss over at least 1 month. Infants with feeding disorder are often irritable, difficult to console during feeding, may appear apathetic and withdrawn, and may also exhibit developmental delays. (DSM IV). Other factors that may contribute to this disorder include parental psychopathology and child abuse or neglect. Specific symptons significant of this disorder are:• Feeding disturbance manifested by persistent failure to
adequately eat with significant failure to
gain weight or significant loss of weight
over at least 1 month
• Feeding disturbance is not due to an associated
gastrointestinal or other medical condition
• often actively defies or refuses to comply with
adults’ requests or rules
• Disturbance is not better accounted for by another
mental disorder or lack of available food
• The onset is before age 6

Note: The above lists are not intended for the use of diagnosing disorders. Disorders are diagnosed by the severity, frequency and a combination of many factors. Please seek professional advice should any of the above listed criteria cause any concern.

How could I know the difference between a warning sign and an appropriate behavior?answer: Know the warning signs.Warning Signs and Behaviors:Oppositional Defiant DisorderOppositional Defiant Disorder is significant for a recurrent pattern of negative, defiant, disobedient, and hostile behaviors toward authoritative figures. These behaviors consist of losing temper, arguing with adults, deliberately doing things to annoy others, actively defying or refusing to comply with rules or requests, blaming others for his/her own mistakes or misbehavior, being touchy or is easily or easily annoyed by others, being angry and resentful, or being spiteful and vindictive (DSM IV). Behaviors would lead to significant impairment in social, academic, or occupational functioning. Some of the symptoms significant of this disorder are:Pattern of negativistic, hostile, and defiant behavior lasting at least 6 months: • often loses temper • often argues with adults • often actively defies or refuses to comply with adults’ requests or rules • often deliberately annoys people • often blames others for his/her mistakes or misbehavior • is often touchy or easily annoyed by others • is often angry and resentful • is often spiteful and vindictive

Note: The above lists are not intended for the use of diagnosing disorders. Disorders are diagnosed by the severity, frequency and a combination of many factors. Please seek professional advice should any of the above listed criteria cause any concern.

How could I know the difference between a warning sign and an appropriate behavior?answer: Know the warning signs.

Warning Signs and Behaviors:Conduct DisorderConduct Disorder is significant for a repitive and persistent pattern of behavior where the basic rights of others, age-appropriate norms or rules are violated. These behaviors consist of aggressive conduct that causes/threatens physical harm, non-aggressive conduct causing property loss or damage, theft or deceiptfulness, and serious violations of rules (DSM IV). Severity of this disorder varies from mild, moderate and severe. Some of the symptons significant of this disorder are:Aggression to people & animals:
• often bullies, threatens, or intimidates others
• often initiates physical fights
• has used a weapon that can cause serious physical
harm to others (e.g., knife, gun, broken bottle, a bat)
• has been physically cruel to people
• has been physically cruel to animals
• has stolen while confronting a victim (e.g., mugging,
purse snatching, armed robbery, extortion)
• has forced someone into sexual activityDestruction of property:
• has deliberately engaged in fire setting with
the intention of causing serious damage
• has deliberately destroyed other people’s property
(other than by fire)Deceiptfulness or theft:
• has broken into someone else’s home, building, or car
• often lies to obtain goods or favors
or to avoid obligations (e.g., ‘cons’ others)
• has stolen items of nontrivial value without
confronting a victim (e.g., shoplifting- without
breaking and entering, forgery)Serious violations of rules:
• often stays out at night despite parental
prohibitions, before age 13 years
• has run away from home overnight at least
while living in parents/surrogate’s home
• is often truant from school, beginning
before age 13 years

Note: The above lists are not intended for the use of diagnosing disorders. Disorders are diagnosed by the severity, frequency and a combination of many factors. Please seek professional advice should any of the above listed criteria cause any concern.